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Weighing in on “To the Bone”

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Eating Disorders Expert Reviews To the Bone

As a Registered Dietitian specializing in eating disorders, To the Bone, the Netflix movie about a young woman with anorexia nervosa, has been a recent hot topic among my eating disorder colleagues and in my sessions with clients. Lead actress, Lily Collins, and writer/director Marti Noxon, have both been open about their personal battles with eating disorders and have promoted their movie as a way to spark important conversations about these serious illnesses.

I completely agree that we need to be talking about eating disorders more, and if the media buzz and ongoing commentaries about To the Bone are any indication, this movie has accomplished that goal. But is starting a dialogue about eating disorders a good enough outcome to justify the potential harm this movie may cause?

Whatever positive intentions may have been behind To the Bone, it fails both as a film made purely for entertainment purposes, and certainly as an eating disorder advocacy piece. I agree with the criticism that this film perpetuates stereotypes about eating disorders. It often felt like the writers had a checklist of eating disorder symptoms and behaviors they arbitrarily ticked off to try to bring authenticity to the story (Lanugo – check. Chewing and spitting – check. Body checking – check.), but it didn’t work.

My concern with To the Bone is that the graphic depictions of eating disorder behaviors and close up shots of the lead character’s extremely thin body may be harmful to those currently dealing with an eating disorder and those at risk of developing an eating disorder. But more importantly, I strongly disagree with many of the messages in this movie, including:

You have to hit “rock bottom” before you will recover. With eating disorders, rock bottom can mean irreversible medical complications, including death. Eating disorders are serious, but treatable conditions. The goal is to intervene as soon as possible before severe consequences occur because the sooner a person gets treatment, the better the chance of recovery. The last thing we want is for anyone to think they aren’t sick enough to seek help.

You have to be fully ready to recover for treatment to work. Ambivalence about recovery is extremely common. Many of my clients don’t feel completely ready for recovery when they start treatment – and that’s ok! Part of them wants to recover, and part doesn’t. Part of them recognizes the negative impact of their eating disorder, while another part isn’t ready to give it up. Especially in the early stages of recovery, when malnutrition makes it hard to think rationally or see the effects of the eating disorder clearly, the healthy voice that wants to get better may barely be a whisper. But that’s no reason to delay getting help.

You’ll be able to eat in a way that supports recovery without any guidance or supervision. The patients in the treatment facility in this movie are seemingly on their own to decide what to eat, how much to eat, and even if they will eat. The group meals are completely unsupervised and there are more eating disorder behaviors around the table than there are people (one patient eats peanut butter straight from the jar for dinner, while another pushes a couple eggs around her plate for most of the meal, etc.). I don’t know of any treatment center that would advocate this approach because nutrition is such a key part of recovery. Learning to eat in a way that provides adequate energy and nutrients for healing while challenging the food rules and rigidity of an eating disorder doesn’t happen spontaneously – it requires specific guidance, support, monitoring, and healthy role modeling from a dietitian and the rest of the treatment team.

It’s possible to lose weight and become underweight in a healthy way. There’s been a lot of criticism about Lily Collins’ weight loss for this role, which she’s defended by saying it was done “safely” under the guidance of a nutritionist and was necessary to tell this story (I’d love to know who that nutritionist is! I’ll bet it wasn’t an eating disorder specialist!). First of all, having an emaciated body is not mandatory to portray someone struggling with an eating disorder. There are many women with serious eating disorders that don’t appear obviously underweight (even though they are at too low of a weight for their body). Even if the actress or director felt this character needed to look underweight, wonders can be done with makeup, wardrobe, and special effects. Bottom line: Losing weight to become underweight CANNOT be done in a healthy way. More importantly, weight loss is a major trigger for relapse from an eating disorder, making it both unhealthy and unsafe for Ms. Collins.

Spreading inaccurate and potentially harmful messages like these is irresponsible, particularly for a film that claims to want to help those with eating disorders. So when clients ask me if I think they should see To the Bone, my answer is NO because this movie is unlikely to help in their recovery and it is likely to be extremely triggering.

7 Vegetarian Diet Myths – Busted!

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Vegetarian Diet MythsWhether you are vegetarian, vegan, or know someone who is, you have probably heard one of these myths. It’s time to reveal the truth about these all too common misconceptions and hopefully put them to rest once and for all. Let the myth busting begin.

7 Vegetarian Diet Myths – Busted!

MYTH 1: Vegetarian and vegan diets don’t have enough protein

Vegetarians (those who don’t eat meat, poultry, or fish, but may include eggs and/or dairy foods) and vegans (those who don’t eat any animal products) can easily meet their protein needs by consuming a varied diet that provides enough energy (aka calories). Beans/legumes, nuts, seeds, soyfoods, and seitan are all good plant-based protein sources. Milk, cheese, yogurt, and eggs are good sources of protein for vegetarians who choose to include these foods. Whole grains and vegetables provide small amounts protein that also help in meeting overall requirements.

MYTH 2: Quinoa is a good source of protein for vegetarians

Quinoa is a healthy grain choice for vegetarians and omnivores (quinoa is technically a seed, but nutritionally it belongs in the grain group). Like other whole grains, quinoa contains some protein, but quinoa is NOT a high protein food. One cup of cooked quinoa has about 8 grams of protein. Check out the protein content in these foods for comparison:

– 1 cup cooked whole wheat pasta: 7 grams protein
– 1 cup cooked oats: 5 grams protein
– 1 cup cooked brown rice: 5 grams protein
– 1 cup of cooked lentils: 18 grams protein
-1/2 cup firm tofu: 10-20 grams protein (protein content varies a lot by type and brand)
-1/2 cup tempeh: 15.5 grams protein
-3 oz seitan: 22.5 grams protein

As you can see, the amount of protein in quinoa is more in line with other grains than it is with protein foods like lentils, soy, and seitan. No one is calling pasta a protein, so let’s stop calling quinoa one.

MYTH 3: Vegetarians need to carefully combine proteins at meals

Decades ago, vegetarians were instructed to carefully combine proteins at each meal to make “complete” proteins. Plant foods low in one of the essential amino acids would need to be eaten with a complementary food that was high in that amino acid to ensure protein needs were met. We now know it is unnecessary to combine foods in this way. As long as a variety of plant proteins are eaten throughout the day, there is no need to combine specific foods at each meal.

MYTH 4: Vegetarians need to eat soy and soy causes cancer

Although soyfoods are a good source of important nutrients like protein, iron, folate, potassium, and (in some forms) calcium, eating soy is not required on a vegetarian diet. There is also no reason to avoid soy for fear that it is unsafe – unless of course you have a soy allergy.

Soy contains compounds called isoflavones, which are known as phytoestrogens or plant estrogens. There has been some concern that the phytoestrogens in soy could potentially increase the risk of hormone-related cancers. However, most research studies have concluded that soy consumption does not raise the risk of breast cancer or prostate cancer, and may actually be beneficial.

So how much soy is ok to eat? Most adults can safely consume up to 3 servings of soyfoods per day. According to the American Cancer Society, this amount is safe for breast cancer patients as well.

MYTH 5: Vegetarian = healthy

Plant-based diets are associated with a lower risk of high blood pressure, heart disease, cancer, and diabetes. But simply avoiding meat is not enough to ensure these health benefits. No one would argue that a diet full of potato chips, ice cream, and cookies is healthy, yet all these foods are vegetarian. Foods like chips and desserts can fit into an overall healthy diet, but they can’t be the basis of one – whether you are vegetarian or not. To reap the health benefits of a plant-based diet (or any diet for that matter), focus on eating a variety of nutritious, whole foods like vegetables, fruit, whole grains, beans/legumes, nuts, and seeds.

MYTH 6: Going vegetarian is a good way to lose weight

Although vegetarians tend to have a lower body mass index (BMI) than meat eaters, becoming vegetarian or vegan does not guarantee weight loss. As discussed in the above myth, vegetarian junk foods abound, and just replacing unhealthy non-vegetarian items with equally unhealthy vegetarian items will neither improve health nor lead to weight loss. In fact, transitioning to a plant-based diet without paying attention to portion sizes or nutrient balance can lead to weight gain, especially if protein foods are replaced with carbohydrates. In addition, just like meat-eaters, vegetarians can struggle with emotional eating, binge eating, and other disordered eating behaviors that may contribute to weight gain. Switching to a plant-based diet without dealing with the underlying issues will not result in sustainable weight loss.

MYTH 7: Vegetarians and vegans need to take lots of supplements

A well-balanced, plant-based diet can provide all the necessary vitamins and minerals except for vitamin B12, which is not present in plant foods. Dairy products and eggs contain some vitamin B12, so vegetarians who consume these foods regularly may not need a supplement. However, vegans and vegetarians with low intakes of dairy and eggs will need to eat foods fortified with vitamin B12 (such as fortified soy milk, fortified cereals, and nutritional yeast) or take a supplement to prevent deficiency.

Other nutrients that require attention on a plant-based diet are iron, calcium, vitamin D, and omega-3 fatty acids. With some effort and planning, it is possible to get enough of these nutrients by eating a healthy, varied diet and getting some sun exposure (one of the main sources of vitamin D). However, some vegetarians and vegans may still benefit from supplementing their diet. In particular, women who are pregnant or breastfeeding, athletes, and those with chronic medical conditions should discuss the need for supplements with their doctor and/or dietitian.

Top 5 Dancer Diet Mistakes

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Dancer Diet MistakesDancers are artistic athletes. They need the strength and energy to meet the physical demands of training and performing and they also need to maintain the aesthetic requirements of their art. Figuring out the best way to eat to achieve both can be challenging. And unfortunately, the pressures of the profession, the abundance of misinformation, the influence of fellow dancers, and the lure of the magical quick-fix can lead to following a diet that is more harmful than healthy.

Unhealthy diets are usually overly restrictive and difficult to sustain. They can lead to decreased strength, energy, and focus, and increase your risk of injury. No dancer wants that. To avoid the pitfalls of unhealthy diets, first you have to know what to look out for. Here’s a list of the Top 5 Diet Mistakes I often see dancers make (and made myself as a dancer before I knew better!).

Top 5 Dancer Diet Mistakes

1. Following a low-carb diet.

Although carbohydrates (aka carbs) are often demonized, they are an essential nutrient – especially for dancers and other athletes. Carbs are the main source of fuel for your brain and muscles, so it’s not surprising that low-carb diets often cause fatigue and make it harder to focus.

On the other hand, eating the right amount and type of carbs will improve your energy levels and concentration, making it easier to pick up and perform difficult choreography. Getting enough carbs in your diet also ensures that protein can be used for muscle repair (this is known as the protein-sparing effect of carbs). Whole grains, high-fiber starchy vegetables, beans/legumes, and fruit are all good carb choices. If you are interested in learning more about carbs, check out this article.

2. Eating too little.

Dancers are prone to undereating. For some, long rehearsals and busy schedules make it tough to fit in enough at meals and snacks. For others, the pressure to achieve or maintain a certain weight or body composition can lead to cutting back too much on important nutrients. Regardless of the reason, under-fueling can have serious consequences for a dancer’s health and career such as muscle loss, bone loss, weakened immune system, and increased risk of injury.

3. Ignoring Meal and Snack Timing.

It’s not just what you eat, but when you eat it that’s important. Getting the right balance of nutrients at the right time can help sustain energy levels, prevent digestive problems, and aid in muscle recovery and injury prevention.

Here are some Performance Meal Timing Tips to get you started:

  • Have a well-balanced meal including carbohydrates, protein, and fat about 3-4 hours before a performance.
  • Have a carbohydrate-rich snack 30-60 minutes before the performance to “top off” your energy stores. A piece of fruit, handful of dried fruit, or sports drink are good choices.
  • Limit fat and fiber in pre-performance meals. These nutrients slow down digestion and may cause stomach upset – especially when combined with nerves (so large salads are usually not the best pre-performance choice!).
  • Have a snack that includes both carbohydrates and protein after the performance – ideally within 30 minutes of when you finish dancing. Carbs are necessary to replenish the muscle fuel you used up while dancing, and protein is needed for muscle repair and recovery. Recovery nutrition is especially important if you have two performances in the same day. Low-fat chocolate milk, a protein/fruit smoothie, or peanut butter and crackers are all good post-performance choices.

4. Following fad diets.

From cleanses to detoxes to caveman diets, fad-diets are everywhere, and their promises of quick, miracle-like results can be hard to resist. But it’s important for dancers to know that most fad diets don’t have any good scientific evidence to support their claims. For example, there’s no need to do a cleanse or detox diet – your kidneys and liver will cleanse and detox your body naturally! And these diets can have dangerous side effects such as dehydration or electrolyte imbalances.

Most fad diets involve excessive and unrealistic food restrictions that can cause nutrient deficiencies, make you susceptible to injury, and may trigger an eating disorder. Plus numerous studies have found that diets are more likely to cause weight gain than long-term weight loss. Instead of following an ineffective and potentially harmful fad diet, focus on improving your diet in small, sustainable ways that will help rather than harm your health and career.

5. Trying to eat “perfectly.”

The pursuit of perfection can help you continue growing and improving as a dancer, but it’s not a helpful approach when it comes to food. Categorizing foods, meals, or days of eating as “good” or “bad” can cause feelings of guilt, frustration, and deprivation which may lead to overeating or bingeing. Sometimes, the focus on perfect healthy eating can turn obsessive and begin interfering with quality of life (a type of disordered eating known as orthorexia). Remember that there is no such thing as perfect eating – it’s all about balance. Strive to make the healthiest choices most of the time, but leave room to include your favorite foods and treats too.

Interested in learning more? Contact us for more information on our dancer-specific services including the Eat Better Dance Better Nutrition Workshop for Dancers.

The Dangers of Dieting

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Dieting and Eating DisordersIt’s National Eating Disorders Awareness Week, and this year’s theme, “I Had No Idea,” focuses on raising awareness about the possible triggers and warning signs of eating disorders. Being able to recognize these signs, symptoms, and contributing factors makes early intervention possible and can prevent a full-blown eating disorder from developing. Early detection and intervention also increases the chances of full recovery.

According to the National Eating Disorders Association (NEDA) website, 20 million women and 10 million men in the United States will suffer from a clinical eating disorder such anorexia nervosa, bulimia nervosa, binge eating disorder, or an eating disorder not otherwise specified (EDNOS) at some point in their life. In addition, there are many who struggle with disordered eating – unhealthy eating behaviors that do not meet the full diagnostic criteria for an eating disorder, but still have detrimental physical and psychological consequences.

Many factors, both genetic and environmental, can contribute to the development of an eating disorder. Although we can’t do much about our genetics, there are risk factors we can control. I’d like to focus on one of the common catalysts for an eating disorder that is completely preventable – dieting.

Most people embark on a diet with good intentions, hoping to feel better in some way. No one goes on a diet thinking, “This diet won’t work,” or “This diet will damage my health.” But diets don’t work. Research shows us that diets rarely result in long-term weight loss and are actually associated with weight gain.

Diets are more than just ineffective – they can be harmful. As the graphic above shows, 35% of “normal dieters” progress to disordered eating, and of those, 20-25% will develop a partial or full-blown eating disorder. Although it is possible to change eating habits in a healthy, sustainable way, too often what starts as a seemingly reasonable diet plan, morphs into an unhealthy obsession. The hyper-focus on weight loss and/or eating perfectly begins to interfere with daily activities and negatively impact health and quality of life.

Here are some warning signs that your diet may have crossed the line from healthy to harmful:

  • Avoiding social situations that involve food
  • Feeling overwhelmed when unexpected changes occur with your food plan
  • Thinking about food all day (especially the foods that you don’t allow yourself to eat)
  • Ignoring your body’s signals of hunger
  • Feeling constantly deprived and unsatisfied
  • Feeling shaky, weak, fatigued, or irritable
  • Exercising in a punishing way to burn off what you ate or burn X number of calories
  • Frequent worry and anxiety about food
  • Feelings of guilt, disgust, or shame about eating
  • Hair loss, cold intolerance, irregular or absent menstrual cycles, lightheadedness, fainting, excessive weight loss, or digestive problems

If you are experiencing any of these signs and symptoms or are otherwise concerned about your eating habits or feelings about food, consult with a professional – the sooner the better. There is hope. Eating disorders are preventable and treatable. I have the honor of working with courageous men and women every day as they fight against their eating disorders to reclaim their lives. The process can be challenging at times, but the rewards are infinite.

For more information and resources, visit: nedawareness.org

All statistics quoted in this blog, can be found here.

Healthy Packable Lunch Ideas – Good for You and Your Wallet!

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Healthy Packable Lunch IdeasHave you ever missed lunch because you didn’t have time to run out and grab a meal? Then you know firsthand that delaying or skipping meals leaves you feeling ravenous. Being overly hungry can decrease focus and productivity and increase irritability and stress. That’s no fun for anyone!

Bringing lunch from home makes it much less likely that an unexpected meeting or schedule change will keep you from eating a nutritious lunch. Plus, when you are in charge of the ingredients and portions, it’s easier to tailor your meal to your specific nutrition needs, health goals, and taste preferences.

Let’s not forget about the money you can save by bringing instead of buying. Here in NYC, even a basic salad or sandwich can easily cost you $10, and that adds up fast. Packing your own lunch just three days a week could save you over $100 a month. I can think of a lot of ways I’d rather spend $100 than on a boring sandwich or salad. What would you rather do with all your extra cash?

Ready to start bringing your lunch, but not sure what to pack? I recommend including these four components to make a satisfying, well-balanced meal that will keep you feeling energized:

1. Whole Grain (or other high fiber starchy carbohydrate) – Try quinoa, brown rice, sweet potatoes, whole grain bread, whole grain pasta, or beans/legumes (which are a source of protein too).

2. Protein – Try tuna, salmon, skinless chicken or turkey, eggs, veggie burgers, tofu, or tempeh. Dairy foods are another protein option (and a good source of calcium). Choose mostly low-fat and nonfat varieties of milk, yogurt, and cheese.

3. Produce – All fruit and vegetables make good choices, so just pick your favorites!

4. Healthy fat – Try nuts, seeds, avocado, hummus, or olive oil.

Need some meal ideas to get you started? Here are a few of my favorites:

Quick and Healthy Packable Lunch Ideas:

Greek Pasta Salad
Add red and green peppers, cucumbers, cherry tomatoes, olives, and feta cheese to whole grain pasta. Toss with olive oil and balsamic vinegar or lemon juice. Add chickpeas for extra protein and fiber. Tastes great hot or cold.

Quinoa Burrito Bowl
Combine quinoa, black beans, bell peppers, onions (and any other veggie of your choice). For extra protein, add grilled chicken or tofu. Top with salsa and add guacamole or roasted pumpkin seeds for some healthy fat and extra flavor. Also delicious hot or cold!

Asian Pita Pocket
Fill a whole wheat pita pocket with broccoli slaw, shredded carrots, and sliced cucumbers (Tip: to save time, look for prepackaged slaw or other shredded vegetables in your produce aisle). Add a protein of your choice like baked tofu, tempeh, grilled chicken, or shrimp. Top with light ginger dressing.

Peanut Butter and Jelly (with a twist)
Freshen up this old standby by using sliced bananas or fresh berries instead of jam. Choose a natural peanut butter (or other nut butter like almond butter or cashew butter) without added sugar or oils. Serve on whole grain bread – whole grain cinnamon raisin bread is one of my favorites.

Grab-and-Go Lunch
This lunch option is perfect for those mornings when you don’t even have five minutes to spare. You just need to spend just a few minutes once a week prepping, portioning, and pre-packing some of the items. Whole grain crackers are one of the easiest options for the grain component. Baby carrots, cherry tomatoes, and snap peas are no-fuss veggies. Bananas, apples, pears, and clementines are good no-prep fruit choices.

Keep some portable proteins on hand like tuna or salmon packets, pre-cooked/pre-seasoned tofu, lean deli meat, nut butter packets, and hard-boiled eggs (Tip: you can make hard-boiled eggs ahead of time. They will keep for about one week in the refrigerator). Single serving packets of hummus, guacamole, or nuts are easy fat additions. Then, all you have to do is grab one item from each category and go. Voila! You have a well-balanced lunch in less than 60 seconds.

What is your favorite packable lunch?